Healthcare Provider Details

I. General information

NPI: 1639261886
Provider Name (Legal Business Name): VAN BUREN/CASS DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SOUTH ST
LAWRENCE MI
49064-9325
US

IV. Provider business mailing address

260 SOUTH ST
LAWRENCE MI
49064-9325
US

V. Phone/Fax

Practice location:
  • Phone: 269-621-3143
  • Fax: 269-621-2725
Mailing address:
  • Phone: 269-621-3143
  • Fax: 269-621-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: DAWN M ROUSE
Title or Position: ADMINISTRATIVE SERVICES MANAGER
Credential:
Phone: 269-621-3143